Back in the driver’s seat. Finding control in the prenatal medical experience.

My exam was supposed to be routine.  In fact, I didn’t give it much thought.   At 37 weeks plus, your ob-gyn generally requests weekly appointments and often conducts a cervical exam during those, which involves manually measuring the cervix to see if there is any dialation or effacement.  This seemed entirely reasonable to me.  The first two exams had gone off without a hitch.  Some discomfort and minor cramping following the exam, but nothing much to speak of.

But my exam at 39 weeks was entirely different.  I’m not sure if the doctor was more brusque in her movements or if my body reacted differently, but directly following the exam I bled heavily.  Not lightly.  Heavily.  And there was tissue.  I’d read that there can be bleeding following a cervical exam, but this was more than I had anticipated.  Scared, I rushed down the hallway and asked my doctor about it. I was told that this was normal. 

If you’re pregnant, blood loss on this level is especially upsetting.  The bleeding continued into the next day.  I wasn’t hemorraging–there were no Monty Pythonesque founts of blood–but it was frightening.  Not only was I bleeding and cramping, but I had begun to convince myself that the baby was moving less.  I have no idea if this is true or not…  It felt to be true.  It was a rather miserable experience.  I read what I could find online about cervical exams, and the Internet, as always, proved to be good source of both information and mad hysteria.

As I mentioned earlier, the pre-labor pelvic/vaginal exam that measures cervical dilation which is said to help determine how close you are to labor and delivery.  Herein lies the rub.  From what I understand, dilation, effacement, and “ripeness” are not necessarily good determinants of how close you are to delivering.  A woman can be 4 cms dilated at 37 weeks and remain that way for the next three weeks without any going into labor.  Likewise, a woman can go from 0 to 10 in 24 hrs.

Then why give a cervical exam?

One potential benefit to the pre-labor cervical exam is that if you are in extreme discomfort and the slightest bit dilated, it is possible for the doctor to induce you.  However, if you are not interested in being induced, then the information from the cervical exam will be of little use to you.  Some women find the exam reassuring if they see a weekly progression in dilation.  Overall, though, I am finding little in the way of hard references (articles from medical journals available to the public) that provide any real benefits.  A person could argue, and many midwifes and LLCs do, that the cervical exam is completely unnecessary and in addition to stressing the mother, could provide a window for infection.  On a more alarmist note, there are stories littering the Internet of doctors sweeping the membranes during a routine cervical in order to aid the mother in inducing.

Reading information like this is not like slipping into a warm bath with cup of tea on hand.  I felt paranoid and my trust in my doctor was diminished.  Not because I believed she would induce me without discussing this option with me (which I don’t think she ever would), but because the procedure’s benefits sounded so nebulous.

I discussed the situation with my husband and my mother.  Both seemed to think that I was right in feeling that the exam had been unnecessary, and both supported my right to refuse it.  I wrote to the lovely lady behind Woman to Woman Childbirth Eduction, just for an opinion.  She was clear in stating that she felt the cervical was unnecessary and that I had every right to decline.  And that was something I needed to remind myself–I didn’t have to do this if I didn’t want to.

At my next appointment, my doctor walked in, greeted me, and as she talked about her stressful day, quickly pulled out the stirrups.  Whoa.  I had to stop her and say, “Can I talk to you about the cervical?”  I could tell it wasn’t really a welcome discussion.  It felt like a confrontation, which probably  had more to do with my nerves and discomfort in broaching the subject.  I asked if she really thought it was necessary.  She indicated that she would prefer to do it, which didn’t quite answer my question.  Then I told her about my fears and reiterated that the blood had seemed unusually heavy.  She nodded, but I got the feeling that her day had been frustrating and this was one more drop in the bucket.  She again told me that the blood was normal, but said that she would be very gentle this time.  I also brought up the question of whether or not I could be accidentally induced.  This was obviously a disagreeable subject that hints at responsibility, malpractice, and a variety of other litigious red flags for doctors.  I appreciate the position.   But these are questions that women need to feel comfortable asking their physicians.  And while I’ve slanted this post towards pregnancy and women, it’s not just about being a woman or being pregnant.  It’s about being a patient and a customer.  This is my body and I want to understand to the best of my ability, what the expert in whom I’ve entrusted it is doing.

I did agree to the exam.  It was painless, without bleeding or cramps.  Yet this reinforced my initial response to the previous week’s.  Which was that the excessive bleeding had not been normal.  I left the office feeling more frustrated and mistrustful–an unfortunate outcome.  And while my doctor had listened, she had done so in a slightly defensive manner.

Does this mean I don’t trust her to deliver my baby?

Not at all.  I think she’s going to be more than competent in the delivery room. I’ll go a step further: I think she’s a good doctor. But I also think she’s used to her routine and patients who don’t ask questions.

It was a rotten reminder. 

Somewhere along the line I had given up too much control. I had a choice that I was unaware of.  And I wasn’t asking enough questions–I was just going along for the ride.

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